I represent a 501(c)(3), tax exempt, nonprofit organization or educational institution.

Yes

No

The 501(c)(3) organization or educational institution is located in Durham, Orange, Wake, Alamance, Caswell, Chatham, Franklin, Granville, Harnett, Johnston, Nash, and/or Person Counties of North Carolina.

Yes

No

The computers for which I am applying will not be sent outside of North Carolina.

Yes

No

The computer(s) I am applying for will serve one of the following primarily:

A low-income, K-12 student at home to support the applying agency's efforts to mentor, tutor, or otherwise provide direct support or educational services to the receiving youth

A low-income individual with a disability at home to support the applying agency's efforts to provide the best possible social service support for their clients

A school program with limited funding to improve computer access for the students. Examples of qualifying school programs are ESL, special education, newspaper club, theatre club, arts club, athletics department etc.

Health and human service nonprofit(s) which support ending homelessness

Operational support for the Triangle United Way Partner Agency or NC United Way which is applying for the computer(s)

None of the above

The organization I represent is primarily a health and/or human services nonprofit and the organization's primary purpose is NOT the promotion and advancement of a religion, political party, or a commercial for-profit entity.

Yes

No

I have authority from the president or executive director of the organization I represent to apply for computers on behalf of the organization.

Yes

No